Managing More and More Meds: Tips for Medication Safety

Transcription

1 Managing More and More Meds: Tips for Medication Safety Alicia B. Forinash, Pharm.D., FCCP, BCPS, BCACP Associate Professor of Pharmacy Practice St. Louis College of Pharmacy

2 Medication Safety 66% leave the physicians office with prescriptions 3.4 billion prescriptions in % increase from 1995 Medication Misuse Annual cost of drug related illness and death $177 billion (2000) Importance of protecting yourself or playing an active role 1 Miller L, ed. Chain Pharmacy Industry Profile. NACDSFoundation; 2006, pg 8. 2 Kaufman DW, et al. JAMA 2002;287: Aspden P, et al. The National Academies Press; Ernst FR, et al. J Am Pharm Assoc: 2001;41: Farley D. FDA FDA Consumer Magazine 1995.

3 Medication Safety Patients who understand instructions and take medications correctly Visit doctors less often Fewer hospitalizations Improved health outcomes Increased patient satisfaction Wolf MS, et al. Am J Health Syst Pharm 2006;63: Weiss BD. 20 Common Problems in Primary Care. New York: McGraw Hill; Baker DW, et al. J General Intern Med. 1998;13:

4 True or False? If you are going to the physician s office and need to fast for blood work, you should skip your medications that morning. False

5 At Your Visit Take your medications before going Go prepared List of questions or problems Bring ALL of your medications Don t forget your OTCs, vitamins, and herbals Bring list of medications that need to be refilled 30 day and 90 day supplies (mail-order)

6 At Your Visit In any week, 4 out of 5 people take a medication When a new medication is prescribed 25% are not told the name of the medicine 35% are told about side effects (only serious) 33% are informed of how long the medicine will be used 50% are given dose and directions Samples Kaufman DW, et al. JAMA 2002;287:

7 True or False? Pharmacists are required by law to educate patients about their medications. True

8 At the Pharmacy Know Your Pharmacist! 35% of patients knew their pharmacists name More likely to Tell them all of your medicines Read product labels Know ingredients of the product Ask health related questions APhA

9 At the Pharmacy OBRA 90 Requires prescription education Most people turn down the education or don t realize they have the opportunity Ask Questions! Take time to listen to the pharmacist If you are not getting the help you deserve, go to a different pharmacy

10 At the Pharmacy Use only 1 pharmacy Provide them with a complete med list Call for refills before you run out Set reminders on calendar Purpose, Proper Use, Potential Side Effects Ask about drug and food interactions Over-the-counter meds, Grapefruit Protect against Look Alike-Sound Alike meds

11 At the Pharmacy Read ingredients in over-the-counter products Same brand name but different ingredients or strengths Herbals Not safer Limited regulation on manufacturing Limited information on safety

12 Medication Questions What is the medicine for? How long do I use it? When should I feel better? What side effects should I watch for? What should I do if I experience these? When should I take it? With or without food? Special administration? Can I drink alcohol while taking it? What if I forget a dose? What to do with current medications?

13 Medication Lists Brand Name Generic Name Strength When to take Directions Flovent Fluticasone 44 mcg inhaler Morning Afternoon Evening 2 Puffs 2 Puffs Shake well. Inhale 2 puffs by mouth with a spacer twice a day. Rinse mouth out after each use.

14 Know Your Medications Brand vs. Generic Equally effective Know both names or check with your pharmacist Duplication risks Know what your medications look like If it is different, check with the pharmacist Check before you crush or split your tablets

15 Know Your Medications Follow the directions Don t double doses, cut in half, or skip doses Don t give others your medications Don t take other people s medications Antibiotics Only effective for bacterial infections Don t push for antibiotics Finish your antibiotics Resistance is on the rise

16 Know Your Medicines Remember to take your medicines Establish a routine Use reminders on calendar, , cell phone, etc. Use pill boxes Tell your providers about side effects Discuss concerns Patient assistance programs

17 Food-Medication Interactions Food & Beverage interactions can Prevent med from working Cause a new side effect Cause a side effect to get better or worse Know if your meds should be taken With food After eating On an empty stomach Low fat meals FDA. Avoid Food Drug Interactions. CDER

18 Food-Medication Interactions Avoid Alcohol Antihistamines Acetaminophen Narcotic pain meds Metronidazole* Benzodiazepines Antidepressants Antipsychotics Sleep aids Separate from Food Digoxin Levothyroxine Fluoroquinolones Tetracycline, Minocycline, Doxycycline Antifungals Bisphosphonates FDA. Avoid Food Drug Interactions. CDER

19 Food-Medication Interactions Vitamin K foods and warfarin Tyramine foods MAO-I (Phenelzine, tranylcypromine) Linezolid Caffeine Albuterol, Theophylline Blood pressure or heart medications Potassium Foods and Salt Substitute ACE-I, ARB FDA. Avoid Food Drug Interactions. CDER

20 Food-Medication Interactions: Grapefruit & Lime, Pomelo, Seville Oranges Amiodarone, Dronedrone Statins Apixaban, Cilostazol, Eplerenone, Rivaroxaban Erythromycin Urinary anticholinergics (fesoterodine, solifenacin) Losartan Benzodiazepines Lurasidone, Quetipine, Budesonide rectal Ziprasidone Calcium channel blockers Oxycodone Carbamazepine Pimozide Clopidregrel (ineffective) Quinidine, Quinine Colchicine Scopolamine Dextromethrophan Sildenafil, Vardenafil, Tadalafil Silodosin, Tamulosin Not a complete List Pharmacists Letter 2013 Detail Document

21 True or False? You can store your medications in the medicine cabinet of your bathroom. False

22 Medication Storage At Your Home Cool, dry location Avoid the bathroom or kitchen near the stove Keep away from children and pets Consider locking up Prescription pain killers Anxiety meds ADHD meds Prescription sleep aids

23 True or False Every household should have a bottle of ipecac available. False

24 At Your Home Poison Prevention Keep all meds, chemicals, etc. out of reach Childproof vs. Child Resistant Never call medicine candy Keep in the original containers Keep Poison Control number handy Use Mr. Yuk stickers Review household plants Do not use Ipecac

25 Get a Yearly Medication Check-up Medication therapy management Review Indications Effectiveness Drug Interactions including OTC, herbals Side Effects Look for expired medications

26 Medications: Be Cautious Meet with your MD or pharmacist Look for meds that can increase risk for Weakness Fatigue Fall risk Don t stop any medications without discussing it first!

27 Medications: Be Cautious Non-selective alpha blockers terazosin, doxazosin, etc Benzodiazepines lorazepam, alprazolam, etc Muscle relaxers carisoprodol, methocarbamol, etc Opioids hydrocodone, codeine, oxycodone, etc Typical antipsychotics promethazine, thoriazine, haloperidol, etc Beers List 2012 STOPP and START 2007 and 2008

28 True or False? When you find expired medications, flush them in the toilet. False

29 Expired Medications Do not continue using Less effective Increased side effects Aspirin Increased harm Tetracycline May expire before expiration date Insulin Inhalers

30 Expired Medications Do not flush! Take out of the original container Mix with undesirable things Kitty litter, coffee grounds, etc. Put in a sturdy container Plain box, empty can, sealable bag Throw in trash just before removal Patches

31 Bring a med list Traveling Have your pharmacy and physician phone numbers Medications can be transferred to another pharmacy Vacation refill early if needed Keep in the original container Do not leave in your car Keep in a carry on bag Special note for some items with air travel

32 Preventative Medicine Vaccines Influenza Tdap Pneumovax Hepatitis A Hepatitis B Zostavax Screening Pap/Pelvic Mammograms Prostate Colonoscopy Calcium and Vitamin D Aspirin Statins

33 Estimating Daily Dietary Calcium Intake cups milk/d x 300 mg = mg cups Occ. of yogurt/d x 300 mg = 0 mg Occ oz cheese/d x 300 mg = mg Calcium from other foods Dairy Total mg + 200mg 800 Dietary Total mg

34 Daily Calcium Requirements Age Ca (mg) > Pregnant >18 years old <18 years old

35 Don t forget the Calcium!

36 Form of Calcium (% elemental) Calcium Supplements Calcium Carbonate (40%) Generic Os-Cal Caltrate Viactiv Chews Tums (extra strength) Strength 1250 mg 1500 mg 1250 mg 1250 mg Elemental Calcium 500 mg 600 mg 500 mg 500 mg Tums (regular strength) 500 mg 200 mg Calcium Citrate (21%) Citracal 950 mg 200 mg Calcium Gluconate (9%) 650 mg 58 mg

37 References Agency for Healthcare Research and Quality Federal Drug Association Institute for Safe Medicine Practices Consumer Med Safety US Pharmacopeia American Pharmacist Association

38 Questions?